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Hutchisons Clinical Methods, 23rd Edition .pdf


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Hutchison’s
Clinical
Methods

For Elsevier
Commissioning Editor: Laurence Hunter
Development Editor: Sheila Black
Project Manager: Joannah Duncan/Louisa Talbott
Designer: Stewart Larking
Illustration Manager: Merlyn Harvey
Illustrator: Amanda Williams

Twenty-third Edition

Hutchison’s
Clinical
Methods
An integrated approach to clinical practice
Edited by

Michael Glynn MA MD FRCP FHEA

Consultant Physician and Gastroenterologist,
Barts and the London NHS Trust;
Honorary Senior Lecturer,
Barts and the London School of Medicine and Dentistry;
Director, North East Thames Foundation School,
London, UK

William M. Drake DM FRCP

Consultant Physician, Barts and the London NHS Trust;
Professor of Clinical Endocrinology,
Barts and the London School of Medicine and Dentistry,
London, UK

Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto  2012

© 2012 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the Publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies
and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).
First edition 1897
Twenty-third edition 2012
ISBN 978-0-7020-4091-7
International ISBN 978-0-7020-4092-4
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.

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The
publisher’s
policy is to use
paper manufactured
from sustainable forests

SECTION 



Preface to the twenty-third edition
With each new edition of Hutchison, the question arises as to its relevance to the contemporary
study and practice of medicine. Although updated
with new clinical knowledge, and new priorities and
methods of investigation, the fundamentals of the
book have remained unchanged for many years. By
following the same basic pattern, past and current
editors hope to emphasize the overriding importance of a thorough and systematic approach to
taking a history, examining a patient and formulating
a differential diagnosis, which remains as essential as
ever to providing good patient care.
The complexity and fragmentation of many
modern health systems, and the expectation of some
patients that ‘there is a test for every disease’, work
counter to the application of a basic clinical method,
and also tend to lead clinicians towards incomplete
diagnosis and therefore the wrong management plan
for their patients. In turn, this can lead to overinvestigation, inappropriate treatment and increased
suffering for patients. For many patients, diagnosis
by history and examination alone is far preferable to
the application of complex tests. This saves both the
patient and doctor time, reduces the cost of tests,
helps avoid the potential adverse consequences of
these tests and is universally applicable, both in
developed and less-developed areas of the world.
Complex or expensive tests clearly have an increasing role in modern medical and surgical practice.
They will often reveal new subtleties to oldestablished clinical methods, and their role must be
absorbed into clinical methodology. Every clinical
test and investigation has its own relevance, and
any test, whether simple and old-established, or a
complex modern investigation, should be applied
only when it is likely to yield trustworthy information, and not in other circumstances. To learn these

essentials of practice, the clinical teacher and the
clinical student must work as hard as ever to ensure
that core clinical skills are taught, learned and practised skilfully and appropriately.
Hutchison’s Clinical Methods emphasizes this
approach to clinical medicine, being split into four
sections. The first describes overall patient assessment, and the second assessment in particular situations. The third includes chapters on the core body
systems and the fourth covers clinical methods as
seen by the key clinical specialties. Overall this
forms a logical sequence if read straight through,
but also allows study of each section separately.
The organization of the book still follows the
aims set out by Hutchison with his colleague, Rainy,
in the first edition, published in 1897.
The plan of this new edition continues to emphasize that teaching the medical history and examination in isolation from the process of diagnosis and
planning management is illogical and likely to lead
to error. Therefore, each chapter describes both the
process of history taking and examination, and how
the information gained is integrated into the process
of diagnosis and planning of care, making the book
an essential adjunct to a standard textbook of medicine, surgery or a specialty.
As in all past editions of Hutchison, all the authors
have existing or past links with ‘Barts and the
London’, now consisting of The Royal London Hospital, St Bartholomew’s Hospital and The London
Chest Hospital. The editors gratefully acknowledge
the work of all the current authors, as well as previous authors who have not contributed to this new
edition.
Michael Glynn and Will Drake
Royal London Hospital

v

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Sir Robert Hutchison MD FRCP
(1871-1960)
Clinical Methods began in 1897, three years after
Robert Hutchison was appointed Assistant Physician
to The London Hospital (named the Royal London
Hospital since its 250th anniversary in 1990). He
was appointed full physician to The London and
to the Hospital for Sick Children, Great Ormond
Street in 1900. He steered Clinical Methods through
no less than 13 editions, at first with the assistance
of Dr H. Rainy and then, from the 9th edition, published in 1929, with the help of Dr Donald Hunter.
Although Hutchison retired from hospital practice
in 1934, he continued to direct new editions of the
book with Donald Hunter, and from 1949 with the
assistance also of Dr Richard Bomford. The 13th
edition, the first produced without Hutchison’s
guiding hand, was published in 1956 under the
direction of Donald Hunter and Richard Bomford.
Dr A. Stuart Mason and Dr Michael Swash joined
Richard Bomford on Donald Hunter’s retirement to
produce the 16th edition, published in 1975, and
following Richard Bomford’s retirement prepared
the 17th, 18th and 19th editions. Dr Swash edited
the 20th and 21st editions himself, and was joined
by Dr Michael Glynn for the 22nd edition. Each of
these editions was revised with the help of colleagues at The Royal London Hospital, in keeping
with the tradition that lies behind the book.
Sir Robert Hutchison died in 1960 in his 90th
year. It is evident from the memoirs of his contemporaries that he had a remarkable personality. Many
of his clinical sayings became, in their day, aphorisms
to be remembered and passed on to future generations of students. Of these, the best known is his
petition, written in 1953, his 82nd year:

‘From inability to let well alone;

from too much zeal for the new
and contempt for what is old;
from putting knowledge before wisdom, science
before art, and cleverness before common sense;
from treating patients as cases;
and from making the cure of the disease more
grievous than the endurance of the same, Good
Lord, deliver us.’

Michael Glynn and Will Drake
Royal London Hospital

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